DVT Flashcards

1
Q

Where can DVTs occur?

A
  1. Proximal - popliteal, superficial femoral, deep femoral, common femoral, external iliac.
  2. Distal - soleal, peroneal veins.
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2
Q

What is a DVT?

A

Deep vein thrombosis - blood clot in a major deep vein in the leg, thigh, pelvis, or abdomen, which may result in impaired venous blood flow and consequent leg swelling and pain.

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3
Q

What are the risk factors for DVT?

A

Age, pregnancy, synthetic oestrogen, trauma, surgery especially orthopaedic and pelvic, past DVT, cancer, obesity, immobility.

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4
Q

What is this a presentation of?

Unilateral warm calf, tender, swelling, erythema, pitting oedema.

A

DVT

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5
Q

What is the method of risk stratification in a suspected DVT?

A

DVT specific Wells score:

  1. Active cancer (1)
  2. Recently bedridden >3 days or major surgery in the last 12 weeks (1)
  3. Paralysis, paresis or recent plaster immobilisation of affected leg (1)
  4. Previously documented DVT (1)
  5. Calf swelling >3cm more than contralateral leg (1)
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6
Q

What is the process of diagnosing a DVT?

A
  1. Calculate Wells score
  2. If unlikely, d-dimer, if this is positive then USS.
  3. If likely, d-dimer and USS.
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7
Q

What is the management for a DVT?

A
  1. FBC, PT, aPTT, LFTs, U&Es prior to anticoagulation.
  2. Start treatment in proximal, only start treatment in distal if symptomatic or if risk factors present.
  3. DOAC (dabigatran, enoxaparin) - 3 months if provoked, 6 months if unprovoked.
  4. TED stockings
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8
Q

What is the mechanism of action of heparin?

A
  1. UFH activates antithrombin which inhibits factor Xa.

2. LMWH inhibits factor Xa

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9
Q

What are the side effects of heparin?

A
  1. Bleeding (less so with LMWH)
  2. Injection site reactions
  3. Heparin-induced thrombocytopenia
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10
Q

What is the mechanism of action of warfarin?

A

Inhibits hepatic production of vitamin K dependent coagulation factors (2, 7, 9, 10).

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11
Q

What is the main side effect of warfarin?

A

Bleeding

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12
Q

What are the pharmaceutical and non-pharmaceutical interactions with warfarin?

A
  1. NSAIDs, St John’s Wort, antihistamines, some antibiotics.

2. Cranberry juice/grapefruit, moderate alcohol, sudden diet change.

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13
Q

What are the complications of a DVT?

A
  1. Post-thrombotic stroke - chronic obstruction of venous outflow and/or destruction of venous valves causing venous hypertension.
  2. Pulmonary embolism
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14
Q

What is the advice for DVT and travel?

A
  1. Compression stockings
  2. Leg exercises
  3. Increased water intake
  4. Refrain from alcohol and caffeine
  5. In high risk individuals - single dose LMWH may be considered.
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